Option 2: Hypotension responsive to IV fluids

The patient shows signs of circulatory compromise but does not appear to be at immediate risk for circulatory collapse. He is alert and oriented but feels lightheaded and weak. A portable monitor, already connected to the patient, shows a blood pressure of 102/78 mm Hg, heart rate of 99 beats/minute, and oxygen saturation of 95% on room air.

Question: What should you quickly establish as you begin the focused H&P?

Make your choice, then click on the explanation bubble to reveal the answer.

• Rapid antibiotic therapy
• IV access and cardiac monitoring

As you evaluate the patient, it's important to try to identify the etiology of their hypotension.

Question: What are common causes for the main categories of shock?

Think of at least two for each, then click on the explanation bubbles to reveal some examples.

• Hypovolemic
• Cardiogenic
• Obstructive
• Distributive

Identifying the underlying cause early allows you to tailor your treatment, whether your goal is improving cardiac output, restoring volume, or managing vasodilation.

Question: Which of the following are part of ongoing management for shock?

Make your choices, then click on the explanation bubbles to reveal the answers.

• Assessing fluid response
• Obtaining further diagnostic studies for patients in shock
• Providing respiratory support for patients with severe shock
• Starting vasopressers

That's right—all of the above may be part of ongoing management!

Signs of inadequate response to fluid resuscitation include persistent tachycardia, hypotension, decreased CVP, and urine output < 0.5 mL/kg/hour.

Having considered the possibilities, it’s time to start the workup.

Question: What diagnostics should you order for most patients with undifferentiated shock?

Think of the studies you'd like to order, then click on the explanation bubbles to reveal the answers.

• Laboratory studies
• Imaging
• Other

See “Shock” for a deeper dive into explanations for laboratory findings or review indications for additional studies.

Compare current results to previous studies to determine if abnormal lab or imaging findings are new and likely due to shock or if they are related to chronic conditions (e.g., CKD, chronic heart failure).

Image interpretation

Test your eyes on the following images. Identify the pertinent findings associated with conditions that may cause shock, then apply the AMBOSS overlay to confirm your answers. Bonus points if you can identify the type of shock they may cause.

If you haven't explored the other scenario yet, jump over to “Option 1: Impending cardiovascular collapse.” You can also return to the main module to wrap up “Under pressure.”